CALIBRATION REQUEST FORM

CALIBRATION REQUEST FORM
Contact Information

(person making this request)
Name*
Company*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Company Information

(for whom the artifacts belong)
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this company a licensed service agency as defined by RS 3:4602 et. seq. ?*

YesNo
Billing Information
PO Number
(optional)
Company*
(company to be billed)
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Contact Person*
Billing Department Email*
example@example.com
How do you want to receive your invoice? Invoices will be sent to the address or email above.*

MailEmail

Fees:

Metrology Fees for Calibration Services	Fee	Adjustment Fee
	(per item calibrated)	(per item adjusted to MPE)
Weights up to and including 10 lb or 5 kg	$7.00	$10.00
Weights over 10 lb or 5 kg up to and including 50 lb or 25 kg	$10.00	$10.00
Weights 250 lb up to and including 1000 lb or 500 kg	$25.00	$10.00
Weights over 1000 lb or 500 kg	$50.00	$10.00
5 gal test measures and provers	$30.00

Description of Items

(to be submitted for calibration)
Description of Items*
Please provide: Quantity, Nominal Value, Class, and Serial No. if you are able to do so.
Will this equipment be used for legal-for-trade purposes?*

YesNo
All items used for legal-for-trade purposes will be adjusted to fall within the Maximum Permissible Error for its class. All other industry equipment will be adjusted unless requested otherwise.

Acceptable condition for weights and volumetric test measures:

Weights:
- All weights must be clean and free of rust and other foreign material/contaminants.
- All cast iron weights shall have a fresh, light coat of aluminum spray paint.
- All cast iron weights shall have a legible and unique identifying serial number permanently etched on the surface of the weight.
- Any weight received in poor condition will be rejected and/or returned for repair at the submitter's expense.
Test measures/Provers:
- All test measures must be cleaned with a non-foaming detergent to remove hydrocarbon residue.
- Test measures shall not have rust or dents.
- Test measures shall have a metal identification plate permanently attached to the front of the test measure.
- Any test measure received in poor condition, missing components, or leaking, will be rejected and/or returned for repair at the submitter's expense.
Return Shipping Information

All shipping charges are the responsibility of the company submitting items for calibration.
Do you plan to deliver/pickup yourself?*

YesNo
Shipping Carrier Company*
Account Number*
(of shipping carrier company)
Zip Code*
(associated with the account)
Insurance Amount
Large Item Shipping Information:
- Shipments are to be delivered on your scheduled day. **Do not send anything in advance.**
- Pallets are not to be heavier than 2500 lb.
- You must schedule your own pick up after being notified that weights are ready.
- You must create a Bill of Lading to accompany the pickup. Please send it to metrologylab@ldaf.state.la.us so that we may give it to the driver. **Failure to complete this step may result in delayed pickup.**
- Deliveries and pickups may be scheduled between the hours of 7:00 a.m. and 3:00 p.m. on your scheduled day.
Shipping Address:

Louisiana Department of Agriculture & Forestry

5825 Florida Boulevard

Metrology Laboratory

Baton Rouge, Louisiana 70806

Thank you for considering us for your metrology needs, we greatly appreciate your business. Once you submit the form, laboratory staff will reach out to schedule an appointment for drop off. We strive to have all items calibrated within three business days.
Should be Empty:

Contact Information

Company Information

Billing Information

Description of Items

Return Shipping Information